The Relationship Between Plasma Homocysteine Level And Coagulation And Fibrinolysis In Patients With Acute Cerebral Infarction

Background:Cerebrovascular disease is a general term for cerebrovascular diseases caused by various reasons.Stroke is the main clinical type of cerebrovascular disease,including ischemic stroke and hemorrhagic stroke.The common clinical features are sudden onset,rapid localized or diffuse brain function defect,which is a group of cerebrovascular diseases caused by organic brain injury.Ischemic stroke is cerebral infarction.Homocysteine is a non essential sulfur and non protein amino acid.In recent years,more and more studies have found that plasma HCY is highly correlated with the occurrence and prognosis of acute cerebral infarction.At present,there are many mechanisms in which HCY can cause cerebral infarction,such as vascular endothelial damage,smooth muscle cell proliferation,disorder of coagulation and fibrinolysis system,lipid metabolism and so on.Objective:The correlation between plasma HCY and coagulation and fibrinolysis in patients with acute cerebral infarction was investigated,and the changes in plasma HCY level,blood coagulation and fibrinolysis were observed in patients with acute cerebral infarction with different severity and different causes.Methods:From June 2016 to October 2017,a total of inpatients in the Shaanxi People's Hospital of the Shaanxi People's Hospital were treated the physical examination in the control group(non acute cerebral infarction group,A).Acute cerebral infarction(ACI)were collected from neurology in the Shaanxi People's Hospital from June 2016 to October 2017.Case selection criteria were revised in 2014 revised guidelines for diagnosis and treatment of acute ischemic stroke in China.According to the National Institutes of Health Stroke Scale(NIHSS)score,the severity was divided into 0-4 points(mild,B);5-15(moderate,C);>15(severe,D).According to the international TOAST standard,it was divided into large atherosclerotic type(LAA),cardiogenic(CE),small arteriole embolism(SAA),and others(other etiological SOE+unidentified etiological SUE).The age was less than 18 years old,More than 80 years old,pregnant women,heart failure,pulmonary thromboembolism,severe liver and kidney impairment,hyperthyroidism or hypothyroidism,deep venous thrombosis,severe anemia,malignant tumor,leukemia,multiple myeloma,psoriasis,systemic lupus erythematosus,rheumatism,shock,DIC,emergency diseases such as sexy dye,after big operation,after radiotherapy,after liver lobectomy,thrombolytic therapy,after organ transplantation,aspirin,heparin,folic acid,methotrexate,estrogens,anticonvulsant drugs,etc,were excluded.Basic data,detailed medical history,liver and kidney function,blood lipid,carbohydrate hemoglobin,plasma HCY,coagulation and fibrinolysis indicators were were collected.All data were statistically analyzed by SPSS 19.0 statistical software.The difference was statistically significant.(P<0.05).Results:1.Comparison of general clinical data and blood biochemical data between acute cerebral infarction group and non acute cerebral infarction group.The acute cerebral infarction group was compared with the non acute cerebral infarction group,there was no statistically significant difference(P>0.05)in gender(P=0.478)?age(P=0.491)?BMI(P=0.872)?PLT(P=0.105)?ALT(P=0.837)?AST(P=0.668)?CRE(P=0.339)?BNP(P=0.483).2.Comparison of plasma HCY,coagulation and fibrinolysis in patients with acute cerebral infarction and non acute cerebral infarctionThe acute cerebral infarction group was compared with the non acute cerebral infarction group,there were statistically significant differences in HCY(P=0.021),APTT(P=0.007),Fg(P=0.039)and DD(P=0.045),but there was no significant difference between the PT(P=0.070),TT(P=0.461),and FDP=0.360(P>0.05).3.Correlation analysis of plasma HCY and coagulation and fibrinolysis indexes in acute cerebral infarction group.There was a negative correlation between HCY and APTT(r=-0.314,P<0.05).There was a positive correlation between HCY and Fg(r=0.402,P<0.05).There was a positive correlation between HCY and DD(r=0.192,P<0.05).There was no obvious linear correlation between HCY and PT,TT and PDF.4.Comparison of plasma homocysteine,coagulation and fibrinolysis in patients with acute cerebral infarction(Different integral groups)and those without acute cerebral infarction.HCY in group B,C and D was significantly higher than that in control group(P<0.05),HCY in C and D group was significantly higher than that in control group and B group(P<0.05).The PT in group C was higher than that in the control group(P<0.05).APTT in group B,C and D was lower than that in control group(P<0.05).APTT in group C and group D was lower than that in control group and B group(P<0.05).Fg in group C and group D was higher than that in control group and B group(P<0.05).There was no significant difference in TT value among all groups(P>0.05).FDP in group C and group D was higher than that in control group and B group(P<0.05).DD in group C and group D was higher than that in control group and B group(P<0.05).5.comparison of plasma homocysteine levels,coagulation and fibrinolysis indexes in different types of acute cerebral infarction patients.LAA type HCY increased compared with CE,SAA and other types,and the difference was statistically significant(P<0.05).LAA APTT decreased compared with CE,SAA and other types,and the difference was statistically significant(P<0.05).There was no statistically significant difference between the other groups(P>0.05).Conclusion:1.There is a significant correlation between HCY and partial coagulation and fibrinolysis(APTT?Fg?DD)in patients with ACI.2.The more severe the ACI is,the higher the plasma HCY level is,the more unstable the coagulation and fibrinolytic system is.3.Compared with other types of ACI,HCY may be more strongly associated with large atherosclerosis type of ACI.